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South Dakota rates for HCPCS 65130

Insertion of ocular implant secondary; after evisceration, in scleral shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,995.26 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,071.52 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,122.02 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,380.38 / $2,137.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $1,949.84